Stanford Medicine’s Lloyd Minor on re-conceiving medical education

Stanford Medicine is no stranger to pioneering changes in medical education, so a panel on re-inventing health provider education at the Association of Health Care Journalism 2015 conference this past weekend was the perfect fit for Lloyd Minor, MD, dean of Stanford's School of Medicine. During his talk, Minor highlighted three topics that the school is pursuing in order to "re-conceive education so it better meets" today's needs: team work, data sciences, and value-based health-care delivery.

Eschewing the old model of the omnipotent and self-sufficient doctor, Minor called for schools to "embrace from the very earliest stages that the delivery of health care is a team endeavor." (The days of "see one, do one, teach one" are hopefully over, he said.) As paper records become a thing of the past and genome sequencing becomes even less expensive, we also need doctors who are very comfortable analyzing "big data." "We have available to us a huge amount of data from which we are not extracting enough information," he said before noting that many Stanford med students take classes in computer programming and data science. And, after highlighting the work of Stanford's Clinical Excellence Research Center, Minor described how the new cohort of medical professionals has to have expertise in analyzing innovations based on value, defined as "outcomes divided by cost" - simply improving outcomes is not enough.

According to Minor, the basic goal of innovation should be to embed within the medical school curriculum as much flexibility as possible, since the workforce of the future needs to be diverse in terms of its talents and abilities. After discussing how many medical schools are exploring the "flipped classroom," he noted that "Rote memorization is not the learning technique that's going to address the problems that society has every right to expect health-care professionals to address. One project, one intervention at a time will achieve that transformative impact."

Fellow panelist Henry Sondheimer, MD, senior director of medical education at the Association of American Medical Colleges, also discussed "seismic shifts" in medical education that require "a different culture, a different kind of student, and a different kind of physician." This move from being hierarchical, autonomous, and competitive to being collaborative, service-oriented, and patient-centered is facilitated and reflected by changes such as the new MCAT, which assess not what students know but how well they can use what they know, and includes a new section addressing the psychological, social, and behavioral determinants of health. He stated that in a world where 32 percent of 2nd-year medical students attend lectures rarely or never, 14 percent regularly attend lectures at other medical schools, 40 percent source medical information from YouTube, and 87 percent from Wikipedia, education is not about memorization, but about connectivity. And this is not just in the U.S.: Speaking about a recent trip he took, Sondheimer reported that "Every single medical student at the University of Zimbabwe has a tablet."

Also speaking was Debbie Ward, RN, PhD, FAAN, associate dean of academics at the Betty Irene Moore School of Nursing at University of California, Davis. Starting with the image of bartenders equipped with condoms and clean needles as revolutionary health-care providers in the early age of HIV, she described how the larger contexts in which health occurs are far more important than the small benefits provided by professional health-care delivery. Since "helping people" is still medical students' primary motivation for entering medical school, medical education should prepare students to become health-behavior coaches and reform the public's health education, and to do interdisciplinary work in a world of dismantled hierarchies where patients are experts. They must think of systems as complex wholes, simultaneously following multiple trajectories and changing what doesn't work anymore.

Ward described how UC Davis' School of Veterinary Medicine has spearheaded the idea of "one health" comprising animals, humans, and the environment, wherein health-care providers must tend the Earth as a whole. She asserted that the lack of such integration led to the Ebola crisis, wherein much more was called for than health-service delivery. Innovations in teaching can include not only role play and high-tech mannequins, but practicing "home visits" in glass-walled studios where faculty can help students address health in a way that considers more than the body. Ward joked that after doing years of home visits, she wanted the studio to include a mangy German Shepherd, toppling stacks of National Geographic magazines, and a blaring television, but that didn't happen. In any case, students need to learn integrity, empathy, and authenticity as the cornerstones of health care.

To conclude with Minor's words, "Health care is ripe for interruption by innovation at every level." May we interrupt away!